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Unusual mechanism of complete atrioventricular block following atrial flutter ablation  Frederic Georger, MD, Luc De Roy, MD, Camelia Sorea, Jean-Paul.

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Presentation on theme: "Unusual mechanism of complete atrioventricular block following atrial flutter ablation  Frederic Georger, MD, Luc De Roy, MD, Camelia Sorea, Jean-Paul."— Presentation transcript:

1 Unusual mechanism of complete atrioventricular block following atrial flutter ablation 
Frederic Georger, MD, Luc De Roy, MD, Camelia Sorea, Jean-Paul Albenque, MD, Serge Boveda, MD, Bernard Belhassen, MD  HeartRhythm Case Reports  Volume 1, Issue 5, Pages (September 2015) DOI: /j.hrcr Copyright © 2015 Heart Rhythm Society Terms and Conditions

2 Figure 1 The left part of the electrocardiogram tracing shows typical flutter waves in leads II, III, and aVF conducted in a 2:1 fashion to the ventricles. After interruption of the flutter, a complete atrioventricular block occurs. Following a short pause, the acceleration of sinus rhythm rules out a potential vagal mechanism. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

3 Figure 2 The top electrocardiogram tracings represent ECG, RVA represents a bipolar recording from the right ventricle and HBE recording from another bipolar catheter located close to the His bundle. Coronary sinus pacing at 500 milliseconds was conducted to the ventricles with a 2:1 infranodal block. After the pacing was stopped, we observed a complete infranodal atrioventricular block up to ventricular pacing. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: The left part of the tracing shows atrial pacing at 600 milliseconds (A1-A1) followed by a 400-millisecond coupled extra stimulus (A2) that blocks after a His deflection. Two sinus beats (A3, A4) that occurred after a short pause as well as 2 atrial-paced extra beats were then blocked in the same fashion (cycle length: 600 milliseconds) (A5, A6). Finally, ventricular conduction was restored after a spontaneous ventricular activity (VS) with a left bundle branch block pattern [probably an escape beat (slightly prolonged HV) originating in or near the right bundle branch] followed by paced ventricular complexes (VP). B: The same strip at a lower speed showing the whole sequence (continued tracing) with restoration of normal AV conduction. Other abbreviations as in Figure 2. HeartRhythm Case Reports 2015 1, DOI: ( /j.hrcr ) Copyright © 2015 Heart Rhythm Society Terms and Conditions

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